PB2350: HEMATOLOGIC MALIGNANCIES AND AUTO-IMMUNITY: A CASE SERIES OF 21 PATIENTS
Authors: Hind Hanani, Hajar Khibri, Naoufal Benlachgar, Soukaina Haidouri, Wafa Ammouri, Mouna Maamar, Hicham Harmouche, Mohamed Adnaoui, Zoubida Tazi Mezalek
Journal: HemaSphere (2023)

Topic: 19. Aggressive Non-Hodgkin lymphoma - Clinical Background: The etiopathogenic links between autoimmunity and oncogenesis in hematology is a promising topic of research. The onset of hemopathy on an autoimmune field and vice versa in patients of our department was the opportunity to study these links. Aims: Describe a cohort of patients having both an auto-immune disease and an hematologicmalignancies and find explanatory patterns between auto-immunity and oncogenesis. Methods: Monocentric retrospective observational study including 21 patients admitted to the Internal Medicine and Clinical Hematology department in Ibn Sina University Hospital in Rabat (Morocco) between January 2018 and December 2022 for an autoimmune disease with a history of hematologic malignancy or vice-versa. Results: Patients were mostly female (57 %) with a mean age of 50 years (19-77 years). Thirty-three percents of patients were admitted for a connective tissue disease, 38 % for an inflammatory rheumatism and 29 % for an organ-specific autoimmune disease. Sixty-two percents were put under immunomodulatory (IM) or immunosuppressive (IS) therapy and 19 % under bDMARDs; 11% received IV Ig. Among them 81 % had a history of a lymphoproliferative syndrome (Hodgkin’s and non-Hodgkin’s lymphomas, multiple myeloma and acute lymphoblastic leukemia), 10 % a myeloproliferative syndrome (chronic myeloid leukemia, acute myeloid leukaemia) and 9 % a bone marrow qualitative or quantitative anomaly. A karyotype was performed in 33 % of cases and found a translocation t (9;22), t(4;14) and a translocation t(4;14) associated with IgH-CCND1 rearrangement. The prognostic score was unfavorable in 31 % of cases. Seventy-six percents received chemotherapy. The AID preceeded the malignant hemopathy in half of cases with a mean diagnostic delay of 15 years (1.5-40 years); the malignancy preceeded the AID in 28 % of cases with a mean diagnostic delay of 5 years (0.3-20 years). The diagnosis was concomitant in 22 % of cases. New symptoms’ onset led to the second diagnosis in 62 % of cases, a paraneoplastic assessment in 10 %, a persistence of symptoms despite well-conducted specific treatment in 10 %, therapeutic ineffectiveness in 5 %, the discovery was fortuitous 14 % of cases. Sixty-two percents of patients were exposed before the second disease to an IM, IS or myeloablative therapy with a median duration of 3 years. Therapeutic adaptation was possible in 17% of patients. The dosis had to be doubled in 6% of cases. Death occurred in 17% of patients following progression of the blood disease (10%) or of the AID (5 %). Summary/Conclusion: The high number of patients in a relatively short period of time and the preponderance of autoimmunity preceeding a malignancy confirms the hypothesis of a link between autoimmunity and hematologic malignancies, dysregulation of the immune system being the basis for autoimmunity and increasing the risk of malignancies, with a potential underlying contribution of immunosuppressive therapy. The high proportion of lymphoproliferative syndromes may find its explanation in lymphocytes’ main implication. Keywords: Autoimmunity, Chemotherapy, Lymphoma, Multiple myeloma